Tian Weizhong, Zhang Ji, Chen Jinhua, Liu Ying, Chen Xiaoyun, Wang Ning
Department of Radiology, Taizhou People's Hospital, Taizhou 225300, Jiangsu Province, China.
Department of Radiology, Taizhou People's Hospital, Taizhou 225300, Jiangsu Province, China.
Clin Neurol Neurosurg. 2016 Feb;141:71-6. doi: 10.1016/j.clineuro.2015.12.014. Epub 2015 Dec 21.
The study aims to investigate the magnetic resonance imaging (MRI) findings of intracranial hypotension syndrome (IHS) and the change of quantitative indicators, so as to yield a deeper understanding of the disease.
The clinical data and MRI findings of 26 cases of IHS which were confirmed by lumbar puncture were retrospectively analyzed. Two physicians evaluated the MRI findings including thickening and enhancement of dural, pituitary enlargement, subdural effusion (hematocele), venous engorgement and brain sagging, and measured the quantitative indicators including mamillopontine distance and pontomesencephalic angle. The consistency between the two results of the physicians was assessed by Kappa consistency test. The differences of mamillopontine distance and pontomesencephalic angle between the patient group and the control group were determined by paired t-test. The diagnostic efficiency of mamillopontine distance and pontomesencephalic angle was assessed by area under the ROC curve, and their best diagnostic thresholds were also determined, respectively. Age- and sex-matched healthy volunteers controls (n=26) were recruited and served as the control group.
All of the 26 patients suffered from the characterized by orthostatic headache of IHS. The clinical evaluations of dural thickening and enhancement, pituitary enlargement, subdural effusion (hematocele), venous engorgement by the two physicians showed excellent agreements (κ=0.808, 1 and 0.906, P<0.01), and the clinical evaluations of brain sagging showed medium agreements (κ=0.606, P<0.01). The mamillopontine distance and pontomesencephalic angle of the patient group were 5.4 ± 1.6mm and 47.8 ± 8.7°, respectively, which were obviously less than those of the control group (6.9 ± 1.1mm and 61.0 ± 6.1°, respectively), and the differences were statistically significant (t=-4.563, P<0.01; t=-.329, P<0.01). The area under ROC curve of mamillopontine distance and pontomesencephalic angle were 0.774 and 0.908, respectively, and the diagnostic value of pontomesencephalic angle was higher than that of the mamillopontine distance. The sensitivity and specificity were 73.1% and 73.1%, respectively, when diagnostic threshold of mamillopontine distance was 6.4mm. The sensitivity and specificity were 76.9% and 96.2%, when diagnostic threshold of pontomesencephalic angle was 51.7°.
The MRI findings presented characteristic features of IHS. The quantitative indicators including mamillopontine distance and pontomesencephalic angle were helpful for clinical diagnosis of subjective findings of IHS.
本研究旨在探讨颅内低压综合征（IHS）的磁共振成像（MRI）表现及定量指标变化，以加深对该疾病的认识。
回顾性分析26例经腰椎穿刺确诊的IHS患者的临床资料及MRI表现。由两名医师评估MRI表现，包括硬脑膜增厚及强化、垂体增大、硬膜下积液（血肿）、静脉充血和脑下垂，并测量乳头体脑桥距离和脑桥中脑角等定量指标。采用Kappa一致性检验评估两名医师结果的一致性。采用配对t检验确定患者组与对照组乳头体脑桥距离和脑桥中脑角的差异。通过ROC曲线下面积评估乳头体脑桥距离和脑桥中脑角的诊断效能，并分别确定其最佳诊断阈值。招募年龄和性别匹配的健康志愿者作为对照组（n = 26）。
26例患者均有IHS特征性的直立性头痛。两名医师对硬脑膜增厚及强化、垂体增大、硬膜下积液（血肿）、静脉充血的临床评估显示出极佳的一致性（κ = 0.808、1和0.906，P < 0.01），对脑下垂的临床评估显示出中等一致性（κ = 0.606，P < 0.01）。患者组的乳头体脑桥距离和脑桥中脑角分别为5.4±1.6mm和47.8±8.7°，明显小于对照组（分别为6.9±1.1mm和61.0±6.1°），差异具有统计学意义（t = -4.563，P < 0.01；t = -13.29，P < 0.01）。乳头体脑桥距离和脑桥中脑角的ROC曲线下面积分别为0.774和0.908，脑桥中脑角的诊断价值高于乳头体脑桥距离。当乳头体脑桥距离的诊断阈值为6.4mm时，敏感性和特异性分别为73.1%和73.1%。当脑桥中脑角的诊断阈值为51.7°时，敏感性和特异性分别为76.9%和96.2%。
MRI表现呈现IHS的特征。乳头体脑桥距离和脑桥中脑角等定量指标有助于IHS主观表现的临床诊断。
